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Article Abstract

Initially thought to be virtually free of negative effects, benzodiazepines are now known to carry
risks of dependence, withdrawal, and negative side effects. Among the most controversial of these
side effects are cognitive effects. Long-term treatment with benzodiazepines has been described as
causing impairment in several cognitive domains, such as visuospatial ability, speed of processing,
and verbal learning. Conversely, long-term benzodiazepine use has also been described as causing no
chronic cognitive impairment, with any cognitive dysfunction in patients ascribed to sedation or inattention
or considered temporary and associated with peak plasma levels. Complicating the issue are
whether anxiety disorders themselves are associated with cognitive deficits and the extent to which
patients are aware of their own cognitive problems. In an attempt to settle this debate, meta-analyses
of peer-reviewed studies were conducted and found that cognitive dysfunction did in fact occur
in patients treated long term with benzodiazepines, and although cognitive dysfunction improved
after benzodiazepines were withdrawn, patients did not return to levels of functioning that matched
benzodiazepine-free controls. Neuroimaging studies have found transient changes in the brain after
benzodiazepine administration but no brain abnormalities in patients treated long term with benzodiazepines.
Such findings suggest that patients should be advised of potential cognitive effects when
treated long term with benzodiazepines, although they should also be informed that the impact of such
effects may be insignificant in the daily functioning of most patients.